The Society for Cardiovascular Angiography and Interventions (SCAI) published on 19 January 2011 guiding principles and best practices for the development of radiation safety programmes in cardiac catheterisation laboratories. The focus of this guidance is the need for safe practice and continuing education for all facilities that perform cardiac procedures involving the use of radiation for imaging.

The paper also offers a summary of programme development criteria, including procedural guidelines, appropriate training and education, dose management and monitoring, equipment considerations and potential safety concerns.

Since SCAI’s 1992 publication of “Guidelines for radiation safety in the cardiac catheterization laboratory,” the average procedural radiation dose has increased due to more complex percutaneous coronary interventions and electrophysiology procedures, emphasizing the need for a radiation safety program for all catheterisation laboratories.

“As procedures and technologies improve and enhance patient care, the need increases for education on safe radiation practice to protect our patients and ourselves,” said Charles Chambers, director of the Cardiac Catheterisation Laboratory at Penn State Hershey Medical Centre, Hershey, Pennsylvania, USA, and primary author of the paper. “In procedures that involve radiation, unnecessary exposure can sometimes lead to other unintended health concerns. This paper should be viewed as a valuable resource to help ensure institutions and practitioners have the knowledge and education programmes in place to maintain a safe radiation dose in the catheterisation lab.”

The paper addresses multiple system components necessary for a comprehensive education programme, including:

The designation of a specific radiation safety person to coordinate education and radiation safety issues and to work with the medical or health physicist.

The use of protective garments worn by all personnel in the procedure room when the X-ray beam is on and access to radiation-specific eye protection.

The purchase of quality fluoroscopic imaging equipment to provide greater customisation and more effective dose management, and the positioning of additional shielding equipment and fixed barriers to provide protection from scattered radiation.

The paper also outlines important guidelines for pre-, during and postprocedure dose management, including:

Pre-procedure assessment of risk and informed consent with radiation information to ensure patients are aware of the risks and benefits and the possibility for additional follow up and treatment.

Management of radiation from the beginning to the end of a procedure in the cardiac catheterisation laboratory, including assessing variables and adjusting procedural techniques to ensure minimum radiation dose.

Documentation of postprocedure radiation dose and patient notification, chart documentation and ongoing communication with the primary care provider in cases where the radiation dose exceeded the recommended limit for the procedure, and follow up in patients where adverse tissue effect is suspected.

“SCAI urges institutions with cardiac catheterisation labs to take a careful look at the education programme components and guidelines outlined in this paper to ensure we are consistently providing our patients and ourselves with the safest environment possible for the best possible patient outcomes,” said Larry S. Dean, SCAI president, director of the UW Medicine Regional Heart Centre and professor of Medicine and Surgery at the UW School of Medicine.